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SITE ADDRESS <br />I`lUl 1�1��( <br />LEGA LOT NO. <br />DESC. LI �j <br />F ;RMIT APPLICATIvN <br />CITY OF EVERETT PERMiT SERVICES <br />3200 CEDAR STREET, EVERETi', WA 98201 <br />425-257-8810 - FAX 425-257-8857 - www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />� �; ��-�� (,i/��. PARCEL TAX I.U. t{ <br />)ccC � � `1�2v� p a� �J L� � <br />�I OCK TRACT OR SUBDIVISION M <br />;)UO D-UO 'fEIV1WhLY TI;IL�L1(d> G <br />�uA��. Molver i��t �r�c:llo�cc�cti�l �tv�, <br />TENANT NAME CONTACT F PERMIT <br />Jo/kt�i, M.ot✓e,v <br />N CTOR DDRESS <br />Ja (kb.�, wW lJc�- i�o, n�c�o�qti�i A�- <br />CONTR. LICENSE # <br />A i�TF� <br />U,S E OF BUILDING � <br />C�A�<1(.�'G 1.i�1J1/L"ILSIUtiI T� <br />(i}��'iIC(:,IAILt S'(�1DIJ <br />WORKDESCRIPTION `��I�VLI'LnIVC: <br />�-1 i�.r S-Nt�lo <br />PLUMBING <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilet <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kilchen sink 8 disposal <br />Disliwasher <br />Clolhes washer <br />Water healer <br />Sink (service/badmop/etc.) <br />Backflow prevenl�r <br />Urinal <br />Crinkiny Founlain <br />Floor drain <br />Grease lrap <br />Roof drains <br />Other _� <br />00 <br />HEAT SOURCE <br />Electric Gas Othcr <br />.... .._..�,�� i <br />�vei�-c.H ��� <br />PHONE <br />PERMIT # <br />y 25-�-yv•v� sy <br />,c_ 2yY- C� �e5"`/ <br />. Yl N K� O(VQr ��1C �' LN <br />R <br />�Il( �?.�lY-� bS�j <br />PRICE OF WORK <br />� ,Z 5�53 cr — <br />U�2�1(,�L-" 1t� GFrl�c;�, P�1L1ClUi�L <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C — air handling unils <br />Forced air systems <br />Gas F:ping <br />Water heater <br />Gas freplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhausl fan <br />Heat puinp <br />Unit heater <br />Boiler <br />Re(rigeralion <br />Woodstove <br />O�her� _ <br />CITY OF EVERETT �OCAL SALES TAX CODE IS 3105 <br />I hereby certify lhat I have read and examined this applicalion and know the same to be true and correct. All provis�ons of laws and <br />ordinances goveming lhis type of �vork will be complied with whether specified hereir, or noL The yranting of a permil does nol presume <br />lo give aulhority to vio!ate or cancel the provision o( any other state or local law regulating consiruction or Ihe periormance of <br />consirudion. That I am aulhorized by Ihe owner of this property lo pertorm the work for which application is made and I comply wilh ihe <br />Stale ContractOrs Law,18.27 RCW and 296200 WAC. <br />,, <br />'-�, � l, (� d� l,� � �3 / _/� <br />—��---�=— �, , <br />'rz <br />